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Comparative Effectiveness of Infliximab Versus Adalimumab in Patients with Biologic-Naïve Crohn’s Disease

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Abstract

Background

Direct head-to-head studies comparing the long-term outcomes of infliximab (IFX) to adalimumab (ADA) in Crohn’s disease (CD) are sparse.

Aims

We compared the short-term and long-term efficacy and safety of IFX and ADA in CD.

Methods

We performed a single-center retrospective study including biologic-naïve adult patients with CD who were started on IFX or ADA at the McGill University Health Center. The primary end points were clinical response and remission at 12 months. Secondary end points included corticosteroid-free remission at 12 months, durable remission, and treatment failure with need for steroids, hospitalization or surgery. Safety was also assessed.

Results

Two hundred and twenty patients were included (143 IFX, 77 ADA). Patients on IFX had a higher prevalence of fistulizing or perianal disease and corticosteroid treatment at baseline. Rates of clinical remission and corticosteroid-free remission at 12 months were similar between both groups: 63.8 versus 76.3% (p = 0.139) and 54.1 versus 44.7% (p = 0.354), respectively, for IFX and ADA. Combination therapy led to significantly higher remission rates at 12 months compared to monotherapy for patients on IFX (81.2 vs. 52.1%, p = 0.008), but not for those on ADA. Higher rates of adverse events were reported with IFX compared to ADA (p = 0.006).

Conclusions

Our real-life experience in biologic-naïve CD patients demonstrated that patients started on IFX were more likely to have a harder-to-treat phenotype. Despite that, efficacy end points were similar between both groups. Clinical remission was higher in patients with combination therapy for IFX, but not for those on ADA. This warrants further investigation.

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References

  1. Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323–333. (quiz 591).

    Article  CAS  PubMed  Google Scholar 

  2. Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–1549.

    Article  CAS  PubMed  Google Scholar 

  3. Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337:1029–1035.

    Article  CAS  PubMed  Google Scholar 

  4. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350:876–885.

    Article  CAS  PubMed  Google Scholar 

  5. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–1395.

    Article  CAS  PubMed  Google Scholar 

  6. Feagan BG, Panaccione R, Sandborn WJ, et al. Effects of adalimumab therapy on incidence of hospitalization and surgery in Crohn’s disease: results from the CHARM study. Gastroenterology. 2008;135:1493–1499.

    Article  CAS  PubMed  Google Scholar 

  7. Sandborn WJ, Hanauer S, Loftus EV Jr, et al. An open-label study of the human anti-TNF monoclonal antibody adalimumab in subjects with prior loss of response or intolerance to infliximab for Crohn’s disease. Am J Gastroenterol. 2004;99:1984–1989.

    Article  CAS  PubMed  Google Scholar 

  8. Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut. 2007;56:1232–1239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Rutgeerts P, Van Assche G, Sandborn WJ, et al. Adalimumab induces and maintains mucosal healing in patients with Crohn’s disease: data from the EXTEND trial. Gastroenterology. 2012;142:1102–1111. (e2).

    Article  CAS  PubMed  Google Scholar 

  10. Colombel JF, Schwartz DA, Sandborn WJ, et al. Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Gut. 2009;58:940–948.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Fine SN. Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Inflamm Bowel Dis. 2011;17:667–668.

    Article  PubMed  Google Scholar 

  12. Matsumoto T, Motoya S, Watanabe K, et al. Adalimumab monotherapy and a combination with azathioprine for Crohn’s disease: a prospective, randomized trial. J Crohns Colitis. 2016;10:1259–1266.

    Article  PubMed  Google Scholar 

  13. Doecke JD, Hartnell F, Bampton P, et al. Infliximab vs. adalimumab in Crohn’s disease: results from 327 patients in an Australian and New Zealand observational cohort study. Aliment Pharmacol Ther. 2017;45:542–552.

    Article  CAS  PubMed  Google Scholar 

  14. Narula N, Kainz S, Petritsch W, et al. The efficacy and safety of either infliximab or adalimumab in 362 patients with anti-TNF-alpha naive Crohn’s disease. Aliment Pharmacol Ther. 2016;44:170–180.

    Article  CAS  PubMed  Google Scholar 

  15. Singh S, Heien HC, Sangaralingham LR, et al. Comparative effectiveness and safety of anti-tumor necrosis factor agents in biologic-naive patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2016;14:1120–1129. (e6).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Varma P, Paul E, Huang C, et al. A retrospective comparison of infliximab versus adalimumab as induction and maintenance therapy for Crohn disease. Intern Med J. 2016;46:798–804.

    Article  CAS  PubMed  Google Scholar 

  17. Ma C, Huang V, Fedorak DK, et al. Crohn’s disease outpatients treated with adalimumab have an earlier secondary loss of response and requirement for dose escalation compared to infliximab: a real life cohort study. J Crohns Colitis. 2014;8:1454–1463.

    Article  PubMed  Google Scholar 

  18. Cholapranee A, Hazlewood GS, Kaplan GG, et al. Systematic review with meta-analysis: comparative efficacy of biologics for induction and maintenance of mucosal healing in Crohn’s disease and ulcerative colitis controlled trials. Aliment Pharmacol Ther. 2017;45:1291–1302.

    Article  CAS  PubMed  Google Scholar 

  19. Hazlewood GS, Rezaie A, Borman M, et al. Comparative effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn’s disease: a network meta-analysis. Gastroenterology. 2015;148:344–354. (e5; quiz e14-5).

    Article  CAS  PubMed  Google Scholar 

  20. Romberg-Camps MJ, Dagnelie PC, Kester AD, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol. 2009;104:371–383.

    Article  CAS  PubMed  Google Scholar 

  21. Veloso FT. Clinical predictors of Crohn’s disease course. Eur J Gastroenterol Hepatol. 2016;28:1122–1125.

    Article  CAS  PubMed  Google Scholar 

  22. Kestens C, van Oijen MG, Mulder CL, et al. Adalimumab and infliximab are equally effective for Crohn’s disease in patients not previously treated with anti-tumor necrosis factor-alpha agents. Clin Gastroenterol Hepatol. 2013;11:826–831.

    Article  CAS  PubMed  Google Scholar 

  23. Tursi A, Elisei W, Picchio M, et al. Effectiveness and safety of infliximab and adalimumab for ambulatory Crohn’s disease patients in primary gastroenterology centres. Eur J Intern Med. 2014;25:485–490.

    Article  CAS  PubMed  Google Scholar 

  24. Kopylov U, Al-Taweel T, Yaghoobi M, et al. Adalimumab monotherapy versus combination therapy with immunomodulators in patients with Crohn’s disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8:1632–1641.

    Article  PubMed  Google Scholar 

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Author's contribution

AB and TAT collected the data, analyzed the data, interpreted the data, and wrote the paper; MS, DM, MS, LPS, MA collected the data; AB, WA, UK critically revised the manuscript; PL analyzed the data, interpreted the data, and critically revised the manuscript; TB conceived and designed the research, analyzed the data, interpreted the data, and critically revised the manuscript. All authors approved the final version of the manuscript.

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Authors and Affiliations

  1. Division of Gastroenterology, Montreal General Hospital, McGill University Health Center, 1650, Cedar Avenue, C7-200, Montreal, QC, H3G 1A4, Canada

    Amine Benmassaoud, Talal Al-Taweel, Mark Solomon Sasson, Dasha Moza, Matthew Strohl, Uri Kopylov, Laurence Paradis-Surprenant, Mohanad Almaimani, Alain Bitton, Waqqas Afif, Peter L. Lakatos & Talat Bessissow

  2. Haya Al-Habeeb Gastroenterology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait

    Talal Al-Taweel

  3. Department of Gastroenterology, Sheba Medical Centre, Tel-Aviv, Israel

    Uri Kopylov

  4. First Department of Medicine, Semmelweis University, Budapest, Hungary

    Peter L. Lakatos

Authors
  1. Amine Benmassaoud
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  2. Talal Al-Taweel
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  3. Mark Solomon Sasson
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  5. Matthew Strohl
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  6. Uri Kopylov
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  7. Laurence Paradis-Surprenant
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Corresponding author

Correspondence to Talat Bessissow.

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Conflict of interest

Amine Benmassaoud, Mark Sasson, Dasha Moza, Matthew Strohl, Laurence Paradis-Surprenant, Mohanad Almaimani have no conflicts of interest to declare. Talal Al-Taweel has served as a speaker, a consultant, and an advisory board member for AbbVie, Janssen, and Takeda. Uri Kopylov has served as a speaker and/or consultant for Janssen, Takeda, AbbVie, and CTS and has received research funding from Takeda and Janssen. Waqqas Afif has served as a speaker and/or advisory board for AbbVie, Janssen, Takeda, Merck, Pfizer, Ferring, Shire, and received research grants from AbbVie, Theradiag, and Prometheus. Peter Lakatos has served as a speaker and/or advisory board member for AbbVie, EGIS, Falk Pharma GmbH, Ferring, Genetech, Janssen, Kyowa Hakko Kirin Pharma, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka Pharma, Pharmacosmos, Pfizer, Roche, Shire, and Takeda and has received unrestricted research funding from AbbVie, MSD, and Pfizer. Talat Bessissow has served as a speaker, a consultant, and an advisory board member for Janssen, AbbVie, Takeda, Pfizer, Ferring, Pendopharm, Shire and has received research funding from AbbVie and Janssen.

Additional information

Drs. Amine Benmassaoud and Talal Al-Taweel are considered co-first authors.

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Benmassaoud, A., Al-Taweel, T., Sasson, M.S. et al. Comparative Effectiveness of Infliximab Versus Adalimumab in Patients with Biologic-Naïve Crohn’s Disease. Dig Dis Sci 63, 1302–1310 (2018). https://doi.org/10.1007/s10620-017-4874-6

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  • DOI: https://doi.org/10.1007/s10620-017-4874-6

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